Beruflich Dokumente
Kultur Dokumente
Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palack University, Olomouc,
Czech Republic
Abstract: Tooth decay and dental erosions are the most frequent diseases of hard dental tissues. One
of their origins is poor dietary habits. E.g. consumption of large amount of sweets in combination
with poor oral hygiene can lead to tooth decay. On the other hand frequent consumption of acidic
food can be the reason of erosive tooth wear. Tooth-friendly products are generally known like
products without cariogenic as well as erosive potential. Therefore their consumption is safe for teeth.
They mostly contain noncariogenic sweeteners which can not be metabolised by oral microflora and
do not contain the acids. After their consumption the pH in oral cavity does not decreases under
critical level (5.7 for enamel and 6.5 for dentine). Functional foodstuffs are another group of food
that are safe for oral health. They contain some substances like vitamins, minerals (calcium, fluoride,
phosphorous, iron, copper), casein phosphopeptide amorfous calcium phosphate (CPP-ACP),
glycomacropeptide, xanthan gum, xylitol, that are beneficial for hard dental structures. These
products are dairy products, fruit juices enriched by calcium or fluoride, chewing gums or candies
with xylitol or CPP-ACP and many others. Their regular intake can help to strengthen the hard dental
tissues. So tooth-friendly and functional foods seem to be useful in dental caries and erosion
prevention.
Keywords:tooth-friendly products, functional food, noncariogenic sweeteners, dental caries, dental erosion
I.
Diet plays an important role both in general and oral health. Dietary habits can influence teeth
generally during their development and eruption or locally after eruption into the oral cavity [1].
Tooth decay and dental erosions are the most frequent pathological changes of hard dental tissues.
They are occurred in patients of all age groups with the highest prevalence between adolescents and young
people [2]. One of the main origins of these diseases is poor dietary habits. If the individual consumes a lot of
sweets and does not provide adequate hygiene of oral cavity, so the tooth decay can be gradually developed. It is
well known that tooth decay is characterized by hard dental tissues demineralization caused by organic acids
produced by cariogenic microorganisms of dental plaque through the anaerobic metabolic processes of
fermentable carbohydrates contained in food [3]. Due to these chemical processes (formation of organic acids,
mostly lactic, acetic, propionic and butyric acid) the pH in oral cavity decreases under the critical value (5.5
5.7) that leads to hard dental tissues hydroxyapatite dissolution [3]. If these periods occur frequently, the tooth
decay can be developed. Before the cavity formation this process is reversible and due to remineralization the
lesion can heal [1].
There are a lot of evidences that fermentable carbohydrates especially sugars are the main diet factor of
tooth decay etiology. However sugars alone are not determinant of food cariogenicity [1]. Just if the sugars are
refined and added to foodstuffs, significant number of tooth decay can be present [1]. Added or free sugars are
non-milk extrinsic sugars in combination with sugars in syrups, honey and fruit juices in high concentration.
These free sugars are the major diet factor of tooth decay origin. Due to WHO recommendation their amount
should be no more 10 % of total energy intake [4]. However in many countries their intake is much more higher
that leads to high prevalence of tooth decay among the population of these countries. So one of the most
effective way of dental caries prevention is sugars intake reduction [1]. The sugars reduction in the diet includes
two methods: the first, reduction of total amount of refined sugars with emphasis on necessary intake more fruit,
vegetables and starchy foods and the second, substitution of free sugars in foodstuffs, beverages and
medicines by alternative sweeteners [1].
The main etiological factor of dental erosions are the acids that can have extrinsic source- dietary
acidscontained in fresh vegetables and fruit (especially in citruses), juices, carbonated beverages, wine, pickles,
some mineral waters etc.; acids contained in some medicines (vitamin C, acetylsalicylic acid, iron remedies),
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pH
3.54.0
3.44.7
3.14.2
3.34.1
3.24.7
3.04.2
3.04.5
2.84.0
1.82.4
3.74.7
5.15.7
3.7
3.6
3.2
4.1.4.4
Beverage
Milk
Distilled water
Carrot juice
Apple juice
Orange juice
Grapefruit juice
Coca-Cola
Pepsi
Pepsi Light
Fanta Orange
Sprite
Sports and energetic drinks
Coffee
Black tea
Red wine
White wine
Bear
pH
6.77.0
5.6
4.2
3.4
3.7
2.93.4
2.2.2.6
2.53
3.1
2.86
2.64
3.053.8
2.43.3.
4.2
3.4
3.7
4.05.0
Sports and energetic drinks have both cariogenic and erosive potential. Their main component are
carbohydrates (glucose, fructose, sucrose or glucose synthetic polymer maltodextrin), the main function of them
is supplying of human body by sufficient amount of energy during the exercises. The higher content of
carbohydrates determines their high cariogenic potential. These beverages also contain different electrolytes,
first of all Na+, K+, Cl-which help to maintainthe water electrolyte balance. On other hand they contain just little
amount of ions that are beneficial for tooth structure (Ca 2+, PO43- and F- ) [9]. Their pH is between 2.38 and 4.46.
These beverages also have high level of titratable acidity[10]. Most of them contain citric or malic acids. The
drinks with citric acid have significantly higher erosive potential [11]. It was detected that, individuals
consuming these beverages once per week have four times higher risk of tooth erosions with comparison with
individuals who do not consume sports and energetic drinks [2].
Flavoured beverages except for fruit and cola flavours are generally safe for teeth [12]. Ideal flavours
are the flavours that do not contain acids, like green tea, herbal extracts, mint, flower flavours, banana, coconut
or chocolate. If it is necessary they can be also used in combination with a slightly acidic fruit note (e.g.
combination of banana and strawberry) [12].
However erosive potential of acidic foodstuffs and beverages is done not only by low level of pH, but
also another chemical and physical parameters, like titratable acidity. This is the amount of basic substances that
is needed for neutralization of acids contained in the foodstuff or beverage [2, 13]. The higher value of titratable
acidity needs the higher amount of saliva for neutralization of acidic environment formed after acidic
foodconsumption. Titratable acidity determines the amount of damaging hydrogen ions produced after acid
dissociation that are able to react with the substances of hard tooth tissues. It was determined that fruit juices
have 23 times higher titratable acidity than another drinks with erosive potential (soft drinks, sports and
energetic drinks) [9]. Further chemical properties of foods and drinks, like type, concentration and power of
acids determinedby value of dissociation constant, can also have influence on the erosive potential. Chelation
property (ability to bind the calcium from hard dental tissues hydroxyapatite) or mineral components content
can significantly influencethe foods erosive potential. Mineral components, like calcium, phosphate and fluoride
can reduce the erosive potential[8, 14]. Another factors as frequency, acidic foods method and beverages
consumption, their temperature and adhesion ability can influencethe susceptibility of tooth surface to erosive
damage. For example drinking using strawdecreases the time of drink contact with tooth surface in comparison
with drinking from cup [2, 15]. Frozen beverages have reduced erosive potential [16]. The time during which
the food is present in oral cavity is also important. The most aggressive way of acidic foodstuffs and beverages
consumption is holdingin the mouth, when time of contact with teeth is longer.
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II.
Tooth-friendlyproducts
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III.
Functional food
Some foodstuffs besides macronutrients, mineral components and vitamins contain so called functional
substances that have beneficial effect on human health generally. These foodstuffs and beverages are called
functional. They have besides their main, nutritional, function supporting effect on normal physiological
functions as well as they can help to stop some pathological processes [28, 29]. The history of functional food
starts from 80s years of the 20th century. Due to Food and Agriculture Organization (FAO) the functional food
is defined as food that is a part of diet containing biologically active substances helping to save health and
reduce risk of diseases [28].
Functional foodstuffs are first of all the dairy products with high content of bioactive proteins and
calcium. It is well known from many studies that regular consumption of milk,cream cheese and cheese leads to
reduction of cariogenicity [29]. They contain mineral components (calcium, phosphates), lipids and so called
bioactive proteins like caseinphosphopeptideand glycomacropeptide. These casein derivatives can be also
contained in some beverages, waffles, cookies, chocolate, pudding, nut butter, cereals, gelatin and help to
remineralize hard dental tissues (increase of absorption of calcium, iron and zinc) as well as reduce dental
plaque formation and protect the tooth surface against tooth decay and erosion [28, 29]. Their combination with
amorphous calcium phosphate is patented substance RECALDENT that is a part of many foodstuffs, beverages
and oral hygiene means with anticariogenic and antierosive effects. This substance inhibits the growth of
cariogenic Streptococci as well as forms on the enamel surface the reservoir of mineral components for its
healing after acidic reaction [28, 29]. Dairy products are recommended to be consumed like final product after
main meal and they are both effective in prophylaxis of dental caries as well as erosion. Besides mentioned
active substances they also contained protein binding the folate, lactoferrin, lysocim, lactoperoxidase that in in
vitro conditions inhibit the growth and adherence of Streptococcus mutans [30].
Some fruit and plant also contain functional components. For example cranberries have anticariogenic
effect due to polyphenols and polyalcohols helping to reduce the number and adherence of Stretococcusmutans
on the tooth surface [31]. The similar effect is characterized for cacao that contains procyanidins, antioxidants,
trigonelline and polyfenols. Tea leaves contain catechin that inhibits the metabolism of cariogenic
microorganisms and due to block of glycosyltransferase worsen adherence of some cariogenic bacteria on the
tooth surface [32].
Another group of functional components are some preservatives, like sorbates, benzoates, sulphites
andnitrite that inhibits the growth of cariogenic streptococci [33].
Honey and its products are also very beneficial for general and oral health. It contains phosphate ethers
of glucose and sucrose as well as salts of inositol hexaphosphate acid that in in vitro conditions are able to
interference with cariogenic bacteria and inhibit the adherence of Streptococcus mutans on the tooth surface
[34]. The further honey product with anticariogenic property is the propolis that contains flavonoids and
antimicrobial substances and due to this has biocidal effect on cariogenic bacteria [34].
Probiotics are another foods with functional components. These are the products that contain
microorganisms beneficial for health. These microorganisms can form some antimicrobial substances that
inhibit another, pathological, kinds of microorganisms. Dairy products with probiotic kinds of lactobacillae and
bifidobacteria are widely used in therapy of gastroenterological and gynecological diseases. It was established
that these bacteria can also have anticariogenic effect [35]. Nowadays some probiotic chewing gums and drage
for tooth decay reduction are available on the market. But it is necessary to keep in mind that further clinical
studies of probiotics influence on tooth decay formation and prevention are needed [1].
IV.
Conclusion
Consumption of tooth-friendly and functional products instead usual sweets and foods with high
erosive potential seems to be one of the ways of dental caries and erosion prevention. Use of sweeteners instead
sugar, has positive effect in caries prevention that has been confirmed in many clinical and experimental
studies.Use of reduced-calorie sweeteners in safe for teethconfectionery products provided a tooth-friendly
alternative to confectioneryproducts with sugar. Addition of mineral components like calcium, fluoride,
phosphate to different foodstuffs and beverages reduces their cariogenic and erosive potential. Another
functional components that can be found in different plants, fruit, honey, milk, dairy products, preservatives,
probiotics etc. seem to be also effective addition to complex prevention of these pathological changes of hard
dental tissues. However further investigations in this field are needed.
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